1. Autism
Historical perspectives on autism
Uta Frith
UCL Institute of Cognitive Neuroscience
12th June 2008
Priory Court: 1st Dame Stephanie Shirley Lecture

2. Setting a historical context for our knowledge
How far can we go back in time?
What early sources are there?
What accelerated our current knowledge?
The time line and three centenaries
2020 - 1920 - 1820.......even earlier

3. Landmark date
2020
1943/44
1920 - 1820.......
Leo Kanner (1943)
Hans Asperger (1944)
Each independently identified and named the syndrome
How did knowledge of autism begin?
How it has changed over time?

4. Kanner’s evocative descriptions of the core
features of autism
• Autistic alonenes
• Insistence on sameness
• Islets of abilities

5. 2020 - 1920 - 1820..1805..1790
Further back in time
Some suggestive examples
Short description of a boy at Bethlem Hospital (1805)
Wild boy of Aveyron (ca 1790)

6. 2020 - 1920 - 1820... ... ... ... ... ... 500
Even further back
The holy fools of the Eastern Church
From 4th Century
Isidora, Simeon, Prokopius, Basil

7. What can be gained from historical analysis?
Has autism always been with us?
How did people in the past cope?
What are the universal features?
- independent of cultural context
But, we cannot proceed unless we have
detailed case descriptions

8. 2020 - 1920 - 1820 - 1720
The case of Hugh Blair of Borgue
(ca. 1708 - 1765)
A family feud
Brother began civil suit
to have Hugh’s arranged marriage annulled
on grounds of mental incapacity
Court annulled marriage
Hugh Blair’s mental incapacity confirmed
Statements from 29 witnesses
Direct examination

9. Contemporary portraits by Henry Raeburn

10. Kirkudbright 1792

12. The Edinburgh court in session

14. William Hogarth: His servants painted ca. 1750

15. Descriptions of odd behaviour
• was teased and bullied
• took no notice of strangers
• never took part in conversation
• visited neighbours at all hours
• gave unwanted gifts
• insisted on same place in church
• went to all burials whether invited or not
• collected useless sticks
• carried stones from heap to heap
• watched water dripping
• could read and write
• had prodigious memory
Autistic aloneness
Insistence on sameness
Islets of ability

16. Autism is not new
Distilling the essence of autism across time
need to look beneath the surface
of behavioural descriptions
Autism is universal
despite different cultural manifestations

17. Explanations of odd behaviour
Inability to attribute mental states
to self and others - mindblindness
resulting in lack of reciprocal social
interaction and communication
Good perceptual processing
Attention to detail
Adequate basic information
processing capacity
Autistic aloness
Insistence on sameness
Islets of ability

18. Going Fast forward in Time...
1745 ... ... 1985
The mindblindness hypothesis
Mentalising aka Theory of Mind aka mind-reading
The ability to attribute mental states (beliefs, desires)
To self and others and predict behaviour on the basis of
mental states rather than real states of affairs
If dysfunctional, then lack of reciprocal social interaction, poor
communication - can explain autistic aloneness

19. Mind-blindness or lack of “Theory of Mind”
or “impaired mentalizing”
• Not putting yourself into someone else’s shoes
• Not recognising that what another person knows, thinks or
feels is different from what you know, think or feel
• Not being able to predict what another person will do on
the basis of what they know, think or feel
• Not recognising that inner intentions govern others’ actions
• Not being aware of your own knowledge, feelings

20. Sally has a basket. Ann has a box. Sally puts a marble in her basket
Sally goes out.

21. Naughty Ann transfers marble into her own box.

22. Sally comes back. Where will she look for her marble?
Where she thinks it is!

23. Hugh Blair failed test of Theory of Mind
on 16 July 1747
Judges asked questions in writing and asked him
to write his answers down
He copied the questions!
He did not realise that he knew something that judges did not know
and that they wished to know about.

24. 16 July 1747
Clerk’s writing
answer the following question
What brought you to Edinburgh?
Hugh Blair’s writing
Answer the followin question
What brougt you to Edinbrugh
Clerk’s writing
You are not to copy what is set before
you
but write an answer to this question….
Hugh Blair’s writing
You are not to coppy what his set before you
but write an answer to this question...

25. Fast Forward Again
Fifty years after Hugh Blair
Back to the time line 2020 - 1920 - 1820
1820

26. 1820 - 1920 - 2020
The historical context around 1820
What happened?
Napoleon banished
Regency period (George IV)
What achievements were new?
Ampere studies electromagnetism
Faraday invents electric motor
First fossil recognised as dinosaur
Babbage invents difference engine
Portrait and landscape
by Constable

27. 1820 - 1920 - 2020
1820
What knowledge relevant to autism?
Franz Josef Gall (1758 - 1828)
Mind has a physical seat in the brain
Brain controls emotions and actions
Johann Friedrich Herbart (1776 - 1841)
Mental phenomena can be studied objectively
Principles of education

28. 1820 - 1920 - 2020
The historical context around 1920
What happened?
WWI is over
Bolshevik Revolution in Russia
The Mechanic by F. Leger
What achievements were new?
Einstein completes his theory of relativity
Rutherford split an atom of nitrogen
Insulin extracted to develop diabetes treatment
Vitamin D discovered to treat rickets
Tuberculosis vaccine
A modern skyscraper

29. 1820 - 1920 - 2020
1920
What knowledge relevant to autism?
Neurological syndromes and psychoses
Emil Kraepelin (1856 - 1926)
“dementia praecox”
Eugen Bleuler (1857 - 1939)
“schizophrenia” and “autism”

30. The 20th Century Sources
First recognition of psychiatric disorders in children
In Vienna
Theodor Heller 1908
– dementia infantilis
– disintegrative psychosis

31. The 20th Century Sources
In Moscow
G.E. Suchareva 1926
schizoid psychopathy
relationship to “Dementia praecox”
congenital brain disorder
cerebellum, basal ganglia, frontal lobes

32. “Schizoid Psychopathies
of Childhood”
Grunya Efimovna Suchareva (1891-1981)
Die schizoiden Psychopathien im Kindesalter
1926 Monatsschrift für Psychiatrie und Neurologie, Bd. 60
Translated by Sula Wolff

33. Suchareva - anticipating Asperger
Description of 6 boys aged 10 to 13 years
seen over 3 years in Moscow clinic
• Characteristic mode of abstract thought, absurdities, eccentricities
Autistische Einstellung
• Poor social adaptation; avoidance of peers; loners
• Superficial emotions; hyper- and hyposensitivity
• Poverty of expressions (face, voice)
• Perseveration; echolalia; obsessive tendencies
• Motor clumsiness, mannerisms, poor voice modulation
• Differences to schizophrenia
• Obvious brain basis of symptoms
This work was largely forgotten

34. After 1920
Pediatricians, psychiatrists, neurologists in many
places started to be interested in children with
‘psychotic’ symptoms
Was it only a matter of time for an inspired clinician
researcher to identify autistic children among the
large group of mentally handicapped children?

35. Leo Kanner (1894- 1961)
1943
Autistic Disturbances of Affective Contact
Enduring characterisation
Autistic aloneness
Insistence on sameness
Islets of abilities
Assumed biological basis
but seduced by refrigerator mother theory
Kanner’s concept of autism was
unchallenged for ca. 50 years
Now it refers to a narrowly defined subgroup
on the autism spectrum

36. Hans Asperger
1906 - 1980
1944
Die autistischen Psychopathen im Kindesalter
Asperger assumed that disorder
•has genetic basis
•is life-long
•coexists with high intelligence
Proposed that educational treatment has to be specially
adapted for children
Almost forgotten, but rediscovered in 1990s

37. Scheerer, Rothmann & Goldstein 1945
a neglected landmark paper
A case of ‘idiot savant’: An experimental study of personality organization
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•
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Single case description of a boy
Detailed neuropsychological study
Contrast to Kanner’s autism
Cognitive, not emotional disturbances are seen as primary
Original ideas on impairment of abstract abilities,
anticipating ideas on executive dysfunction
• Attempt to explain special abilities as abnormal perceptual
processes
Kurt Goldstein 1878–1965 Neurologist

38. Stephen Wiltshire drawing from memory
Stephen spent 30 minutes taking in 360 degrees of Tokyo skyline from the roof
top of Roppongi Hills (270 meters up). Over the next seven days he drew, from
memory, a remarkably accurate panorama of the Tokyo skyline

39. A scientific revolution
1960s
• Autism a form of mental retardation
• Due to brain pathology rather than poor parenting
• If so, social-emotional problems may be explained
as consequence of abnormalities in perception
and thinking
• If so, new information processing models can be
applied

40. The 1960s
Beginnings of psychological experimentation
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•
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Removing stigma of poor parenting
More attention to intellectual problems
Less attention to affective problems
Main target language problems
Intervention by operant conditioning

41. Beate Hermelin and Neil O’Connor
“Experiments with autistic children” (1970)
Information processing models
Uneven profile of abilities
Specific deficits
good memory for meaningless
vs poor memory for meaningful
material
Conclusions
not peripheral input/output problems
but central coding difficulties

42. How far did the early experimental work
“explain” autism?
Main features of cases studied in the 60s
– Delayed language, no speech, poor speech
• Ideas on disturbance of semantics and pragmatics
– Learning disability
• Study of memory, attention, perception, motor skills and
learning
• Attempts to differentiate autism from other syndromes with
intellectual impairments were only partially successful
• Social difficulties remained the big unknown

43. The historical context
for the mindblindness hypothesis
How did the hypothesis come about?
Researchers were turning against Behaviourism
Up to then Psychology was the Study of Behaviour
Now the Study of Mental Life
Study of mental states as they influence behaviour
e.g. pretence, deception, belief, knowledge
John takes his umbrella - because he thinks it’s raining,regardless of whether
it is actually raining
1978 David Premack and Guy Woodruff: Does the Chimpanzee have a ‘Theory of Mind?’
1983 Heinz Wimmer and Josef Perner: Beliefs about beliefs

44. The natural life of the mindblindness hypothesis
Step 1 Novel prediction
Children with autism fail to understand False Beliefs while
they understand False Photographs
Confirmation (Baron-Cohen, Leslie & Frith, 1985)
Since 1985 many more confirmations
Step 2 Negative findings
Meta-analysis of studies (Happé 1994)
Children with succeed on False Beliefs with 5-year delay
Step 3 Modifications
Individuals with autism can learn about mental states, but
still lack intuitive mindreading (e.g. Frith 2003)
Step 4 Extensions
Investigations of mind reading in other animals

45. A major step forward
In the 1990s Brain imaging methods become available
Brain imaging was used to visualise brain system that is
active during mentalising
Surprising finding
No matter what the task a specific neural system
is activated during mentalising
In autism
Physiological test
Are their functional differences in relevant brain regions?
Anatomical test
Are there structural differences in relevant brain regions?

46. Castelli et al., 2000
Paracingulate
sulcus
STS-temporalparietal junction
Basal temporal
Mentalising system
Basal temporal, periamygdaloid

47. Evidence for brain abnormality in ASD
linked to mentalising failure
Asperger and HFA group show reduced
brain activation in mentalizing system
but equal activation in visual system
Components show strong connectivity
in the normal brain
But weak connectivity in the autistic brain
Castelli et al. 2002

48. Medial prefrontal region
functionally different in autism
- less activated in autism during mentalising
structurally different in
autism
- smaller volume

49. Recent developments
from mid-1990s
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Search for genetic and other biological causes
Systematic search for intervention
Continued development of diagnostic instruments
Availability of brain imaging techniques allow
building bridges from cognition to brain
• Brain abnormalities may distinguish subgroups,
but have not done so yet

50. The mirror neuron deficit
hypothesis
• Can a deficit in this system explain autism?
– Can perhaps explain lack of emotional resonance, and
lack of learning by imitation,
– but not uneven cognitive abilities, savant talents,
executive dysfunction
• Open questions
– How is empathy related to mentalizing?
– How is introspection into own mind related to reflection
about other minds

51. Has there been progress in
explaining the nature and causes of autism?
100 years ago
autism not recognised at all
50 years ago
psychosocial origin presumed - not brain abnormality
Now
slow but steady progress towards identifying brain
abnormality, genetic risk factors and other putative causes

52. Leo Kanner - the legacy
The name
A clinical entity
Nuclear cases as anchors

53. Hans Asperger - the legacy
• The interest in highly intelligent individuals
– Focus of neuropsychological studies, possibly to the
detriment of studying other individuals with ASD
• The case of extreme male intelligence
– Simon Baron-Cohen’s theory of the Extreme Male Brain
and Systemizing (vs. Empathizing)

54. Kurt Goldstein - the legacy
• Work on frontal lobe dysfunction
• Modularity of mind
• Mystery of the savant

55. Hermelin & O’Connor - the legacy
• Apply neuropsychological methods
• Explain savant intelligence

56. Mindblindness hypothesis - the legacy
Other hypotheses are needed as well
Could be used to identify phenotype
Need for standardised test of Theory of Mind

57. 1820 - 1920 - 2020
2020
What knowledge relevant to autism?
– Genetic blueprint
– Visualising structure and function of the living brain
– Increasing knowledge about the social brain
and its evolutionary origins

58. 1820 - 1920 - 2020
2020 (as seen in 2008)
What progress has been made?
Autism recognised as one of the most prevalent neuro-developmental
disorders, with a basis in the genes
Close to finding biological causes
Close to identifying phenotypes and genotypes
Early diagnosis and intervention
Better educational treatments